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The principles underlying fluid therapy and their application to some medical problems in small animals are presented. The renal mechanisms which normally regulate the volume, electrolyte concentration and pH of extracellular fluid are reviewed. The major clinical disturbances are considered together with the specific means of correcting them by fluid therapy.
An introductory part concerned with the distribution of fluid and electrolytes over the various compartments of the body and the acid-base regulation is followed by a discussion of the fluid balance and pathological losses of fluid and electrolytes. An assessment of patients showing dehydration is based on the histories, clinical examination and laboratory studies, in order to gain an impression of the state of hydration, electrolyte deficiencies, acid-base equilibrium, caloric requirements and renal function. The guidelines for fluid therapy include the scheme of this form of treatment, some comments on the available fluids and the techniques in large and small animals.
Analysis of nearly 90 commercial "clear" fluids, including soups, juices, fruit-flavoured drinks and ices, carbonated beverages and gelatins, showed a range of 0.1 to 251 mmol of sodium and 0.0 to 65 mmol of potassium per litre; the osmolality ranged from 246 to more than 2000 mOsm/kg of water. Knowledge of these values is useful in the home or hospital management of patients for whom control of fluid and electrolyte intake is indicated. The results of the analyses are presented in tabular form for use by physicians and nutritionists when counselling patients to ingest clear-type fluids for various illnesses. Examples are given using these data to show how clear-fluid therapy can be tailored in one such illness--gastroenteritis (infectious diarrhea).
The various routes to the large veins and the technique for placing a long-term plastic catheter for fluid therapy and prolonged total parenteral feeding, are described with respective limitations and contraindications. It is considered that cannulation of the subclavian vein by the subclavicular route using Cavafix instrumentation is preferable because it is comparatively easy to carry out complications are limited, and scrupulous asepsis is possible. It can also be applied in any patient even in the most serious of conditions without having to make him take up a special position.
Impaired peripheral perfusion is a major problem in necrotizing enterocolitis with delayed recognition and definite documentation being primary factors. While blood pressure and other clinical measurements may improperly estimate the severity of the problem, changes in transcutaneous oxygen measurements and their relationship to arterial oxygen (the tcPO2/PaO2 ratio) potentially afford a sensitive measurement of peripheral perfusion. Experience in our unit confirms a close relationship between tcPO2/ and PaO2 being 0.97 +/- 0.04 (SE). Ten infants with birth weights of 640 to 1380 g, who subsequently developed necrotizing enterocolitis, had strikingly lower ratios initially (0.00, 0.00, 0.00, 0.17, 0.21, 0.43, 0.44, 0.48, and 0.56). Use of the tcPO2/PaO2 ratio to monitor fluid therapy was related to outcome, suggesting that this ratio is important in managing necrotizing enterocolitis.
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